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When Mayor Anthony A. Williams took office last January, he acknowledged three hulking management imperatives that neither his predecessors nor the aces at the financial control board had bothered to resolve: the scope and mission of the University of the District of Columbia (UDC), the city government’s relations with labor, and the management of D.C. General Hospital, aka the D.C. Health and Hospital Public Benefit Corp. (PBC).
Eleven months later, Williams has whiffed twice on UDC—by proposing to move the school to Anacostia and then by failing to keep its trustees board in business—and is still working to shove managed competition down the throats of D.C.’s municipal unions.
That leaves the PBC, a policy area in which the mayor no doubt wishes he could wipe the slate clean and just start over. Like most of his first-year political problems, the mayor’s personal health-care crisis started in March, with his budget plan for fiscal year 2000. The mayor essentially signed on to a plan hatched by now-departed-D.C. Medicaid Director Paul Offner to extend health-care coverage to uninsured District residents and pay for the insurance with funds that currently go to institutions such as the PBC and Howard University Hospital—institutions that together absorb a large proportion of nonpaying patients in the city.
The plan sounded simple enough. “What we want to do is change the system from an institution-based system to a patient-based system,” said the mayor in plugging the proposal.
That’s where the simplicity ended. In hearings before the D.C. Council, Williams and Offner confused themselves, the council, and the public about how their plan would be financed, who would benefit, and—this happens sometimes, no matter how often the number-crunchers deny it—just who would lose. Health-care wonks started throwing around terms like “Medicaid waivers” and “Disproportionate Share Hospitals [DSH] payments.” D.C. General supporters painted Offner as a guy out to poke holes in the safety net. Soon enough, the whole debate collapsed.
The result was the extension of the status quo for another year, along with a tiny $6 million pilot program to test the mayor’s plan.
As abstruse as the health-care debate became, however, one notion pierced all the acronyms and health-care-speak: The mayor and Offner were OK with killing off D.C. General, a local institution beloved for adhering to its mandate to provide care to anyone who passes through its front doors. While much has been made of the council’s shedding its liberal heritage in recent elections, the shuttering of the hospital was too extreme for even the most ferocious efficiency advocates. “The PBC is, in my view, an integral part of public health in this city,” says At-Large Councilmember David Catania.
Likewise, the PBC will be an integral part of the budgetary negotiations that should preoccupy One Judiciary Square early next year. And, like all good budget debates, this one involves big-dollar decisions with mortal implications for D.C. residents.
The numbers alone tell much of the story: The PBC’s D.C. General has 250 beds, according to the D.C. Hospital Association. Over 50 percent of its clientele is too poor to pay for care and ineligible for Medicaid. The hospital alone provides 37 percent of all uncompensated care in the city, according to D.C. General. And in return for this free care, the city pays the hospital an annual subsidy of around $32 million and a DSH payment of $3 million. Aided by those contributions, the PBC has shed its red-ink-stained tradition and operated for four consecutive years with a profit, an accomplishment cited often by PBC CEO John Fairman.
Fairman’s political constituency encompasses not only supporters of the indigent and the infirm but also private hospitals in the District—many of which are happy to watch the city’s uninsured land at D.C. General. “There are hospitals that, to this day, drop patients outside our emergency room,” says a PBC official. Last spring, D.C. General’s coalition filled a hospital auditorium to shout down Offner’s scheme and fete the council’s staunchest defenders of the institution—Catania, Ward 8 Councilmember Sandy Allen, and Ward 7 Councilmember Kevin Chavous. This rich-poor coalition is powerful enough to head off any reform that doesn’t begin with preserving the PBC.
The PBC has every right to take pride in its record of providing health care to the 80,000 uninsured District residents. However, the mere existence of such a huge uninsured population is a point of shame. Therein lies the conundrum of the PBC.
Mayor Williams and the council have both pledged to reduce the ranks of the uninsured as part of next year’s budget package. As with this year’s fiasco, though, the trade-off for expanding coverage may well involve cutting the PBC’s subsidy from the District government—a life-or-death proposition for the city’s premier safety-net facility.
“If you give me a Medicaid card but no place to go, you might as well keep the Medicaid card,” says Allen. Any plan to upgrade health care for the poor, she says, must unshackle D.C. General from laws prohibiting it to operate as an HMO or float bonds to fix its crumbling facilities. “The way health plans are falling around the country would dictate that you had better be very careful not to destabilize the largest safety-net provider in D.C.,” says Fairman.
That very sentiment prompted a grass-roots movement to save Greater Southeast Hospital, an institution that was teetering on the brink of closure over a few million dollars. In a buyout plan approved in bankruptcy court last month, Doctors Community Healthcare of Arizona must plunk down $22 million by the end of the month to rescue the facility. Defenders of Greater Southeast pointed out that it is the only major hospital east of the Anacostia River and thus caters to a historically underserved population.
The truth is a bit more complicated. Unlike the PBC’s constituency, nearly all of Greater Southeast’s patients are covered under one insurance plan or another. So if the hospital closes, the PBC might pick up its few nonpaying customers—but the insured folks might well be scared off by D.C. General’s outdated facilities, malfunctioning air conditioning, and fame for providing state-of-the-art care only to gunshot victims.
The same dynamic applies to any D.C. plan to broaden insurance coverage for the indigent: Improve poor people’s access to full health care, and they’ll ditch D.C. General—sinking the very institution that’s been maintained in their name. “The big question,” said Offner at a June congressional hearing, “is what these newly insured individuals would do once they get an insurance card. How many of those who were previously D.C. General clients would take their business elsewhere?”
FARE GAME
LL has figured out just how taxicab drivers pass the time as they wait for fares: They’re figuring out who’s out to get them. The revelation came to LL Nov. 22 at a mayoral town meeting for District hackers held at Ballou Senior High School. If you thought your cabbie spun a good conspiracy theory as he dodged potholes and traffic cops on Massachusetts Avenue, just imagine how he’d perform for Mayor Williams and an auditorium full of colleagues, policy makers, and media types.
Once host Abdusalam Omer, the mayor’s chief of staff, opened the floor for questions, the event turned into something resembling an Oliver Stone screenplay brainstorming session, with each successive taxi driver articulating his own pet theory. Here’s a sampling:
* The Secret Agent Man Theory
Driver Muhammad Ali described the torture imparted by a “hack inspector in a white unmarked car.” The inspector allegedly works from 3 p.m. to 11 p.m. During said period, Ali alleged, this inspector “is constantly harassing cab drivers. He hollers, screams, and he’s spitting in your face when he’s talking, and it seems like he’s on some kind of substance.”
Taxicab Commission Chair George Crawford responded that he knew of no taxicab inspector who drives a white unmarked car.
* The Other Plan
In a rambling, impassioned indictment of taxicab regulation, Mathias Bannister hammered black officers for dishing out exorbitant fines. “White officers will write you a $50 ticket, so that you can pay it,” charged Bannister, who reminded the mayor, “You are talking to a man of wisdom.”
* The Media Conspiracy
After noting that he had been robbed three times and assaulted five times, cabbie Shahzad Chaudhry attributed the industry’s tough luck to the cameras. “The media hype is such that all cabdrivers are bad, don’t speak English, and don’t know where they are going,” he said.
* The Black Helicopter/Blue Van Theory
No list of cabbie curses is complete without the dreaded SuperShuttle, that chain of blue-and-yellow vans that rob D.C. hackers of their most coveted windfall: airport fares. An unnamed taxi driver stood up to denounce SuperShuttle as a “racketeering operation” in which the company’s four owners effectively throttle all competition. Crawford countered that the vans are in fact a “legitimate business.”
Just as LL was sprinting to get the name of the racketeering theorist, he was all but tackled by a hacker who pointed across the room and said, “See that bald cop over there? He is more racist than even Hitler!” Ah, The Lone Gunman Theory.
O, SENATORES
With the sunset of the District’s seven-month-long budget marathon, Mayor Williams these days has managed to banish most of the bureaucratese from his public addresses. Although the mayor did drone on a bit at his Nov. 20 Neighborhood Action summit about the “strategic management cycle,” he’s using layman’s terms to describe his most beloved concepts—like “cost-based accounting” and other participial expressions paired with words like “rationalization.”
Like every recovering wonkaholic, however, Williams hasn’t yet fully, uh, optimized his public-speaking resources. In fact, the mayor appears to have traded in his reliance on budget-office expressions for another annoying tick: the applause line.
To be sure, the mayor’s advisers insist that no one coaches him on methods to enthrall his audience. And LL has no evidence to the contrary. But judging from the mayor’s recent appearance, LL must conclude that he has been sneaking in episodes of The Price Is Right between cabinet meetings and rec center appearances. Like Bob Barker, Williams these days seems to have mastered the art of on-demand applause—without resorting to flashing signs, no less.
Reduced to a formula, the mayor’s emerging applause-prompting strategy boils down to this:
Rhetorical Question/Platitude on Public
Policy + Support-Seeking Question = Cheers for the Mayor.
Confused? Just take this snippet from the mayor’s remarks at the summit:
“How can we be a great city when we don’t support parks in our city? Am I right?” On cue, the audience applauded, signaling to the mayor that he, of course, was right. No self-respecting great city would ever let its parks down.
Confident that his audience wouldn’t dare overrule him, the mayor a few minutes later brandished his new pulpit trick again: “If public space can’t be maintained here…where can we maintain it? Am I right?” [Applause]
On a tear, he switched subjects, but not rhetorical constructs: “Vendors are going to be paid because they achieve results. Am I right?” [More applause] Then he even managed to apply the formula to one of his favorite good-government mantras: “We think there ought to be a scorecard to hold government accountable. Am I right?” [Standing O, confetti, party hats, and kazoos]
In all, LL counted 10 repetitions of the formula at the summit—so many that attendees began adopting the modality in their own conversation. “How can our group continue its discussion of public policy priorities while I go to the restroom? Am I right?” LL asked participants.
POLITICAL POTPOURRI
* When Suspect-for-Life Marion S. Barry Jr. set out to sow civic pride among D.C. residents, he’d usually fall back on the city’s tradition as a compassionate place for the downtrodden and the elderly. His successor seems to have chosen a somewhat more anomalous rallying point: Edge City: Life on the New Frontier, the sprawling 1991 suburban design volume written by Washington Postie Joel Garreau.
In his Nov. 20 neighborhood summit address, Mayor Williams—who called an edge-ish Virginia high-rise his home early in his local residency—cited Edge City as an exemplar of premature thinking that condemns urban centers to extinction. “I hate that book,” thundered Williams to nearly 3,000 onlookers, imploring them to join him in showing Garreau that this old decaying center could gain an edge of its own.
Garreau told LL that he was “flattered” that the mayor “cares enough to mention” the book. The author, nonetheless, expressed his preference for the official reaction of former Houston Mayor Bob Lanier, who “gave away gazillions of copies and saw opportunities to learn from places in the suburbs that have been great successes,” says Garreau. For example, Lanier “observed how malls operated” and “backloaded” those principles into Houston’s old downtown.
To judge from Williams’ pronouncements, he’s ready to “backload” Garreau right into the Potomac. CP
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* In an October hearing, At-Large Councilmember Carol Schwartz learned that city contracting officials in May had extended a contract with Lockheed Martin Information Management Systems (IMS) to provide parking ticket administration and collection services to the District. Schwartz raised no objections to the extension but nearly kicked a hole in the council dais when she learned that it contained a raise for the conglomerate without council consent. Acting Department of Motor Vehicles Director Sherryl Hobbs Newman defended the boost on the grounds that it would compensate the company for adding customer-friendly enhancements to the processing of parking tickets.
One problem: The company has yet to deliver the enhancements. “Why we would give this company more money without the additional services is beyond me,” wrote Schwartz in an Oct. 29 letter to Williams.
The contracting officials at Schwartz’s hearing did not provide figures documenting just how much money the defense titan had earned for doing nothing. In November, the staffers finally supplied them to her public works committee. The damage? Nearly a half-million bucks on an annualized basis.
Schwartz asked for a tally comparing four months under the sweetened extension with what Lockheed Martin IMS had been taking in under the expired contract, yielding a gap of $140 million. “This clearly circumvents the council’s statutory authority,” says Schwartz, who is on a mission to stop officials in the District’s central procurement office from altering contract extensions.
Chief Procurement Officer Elliott Branch defends his office’s actions—sort of. “What we did was legally and technically correct,” says Branch, “but not a particularly good business approach.” That, of course, depends on whose business you’re talking about.